045: Testosterone and OSTEOPOROSIS in MENOPAUSE

In this episode of The Strong Bones Coach Podcast, Carly explores the essential role of testosterone in women's health, particularly its impact on bone density and muscle mass. She busts common myths about testosterone, explains the benefits of supplementation, and shares practical tips for maintaining healthy testosterone levels. 

Carly also discusses recent media coverage about the challenges women face in accessing testosterone therapy. Tune in to learn how to support your bone health and overall well-being with testosterone.

Key Questions Covered:

- What is testosterone and how does it work in your body?

- Why is testosterone important for women's health, especially during menopause?

- How can testosterone support your bone health?

- What are the common myths and facts about testosterone?

- How can you access testosterone as part of your Hormone Replacement  Therapy and overcome challenges?

References:
Testosterone therapy in women: Myths and misconceptions. Constantine and Dimitrakakis. 2013
LINK >>> https://doi.org/10.1016/j.maturitas.2013.01.003

Association between testosterone levels and bone mineral density in females aged 40–60 years from NHANES 2011–2016. Zhang, H., Ma, K., Li, RM. et al. Sci Rep 12,  (2022).

LINK >>> https://doi.org/10.1038/s41598-022-21008-7

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Transcript

Carly: 0:37

Hello and welcome back to the strong bones coach podcast with me your host Carly. Now this week we are looking into an important but often misunderstood area within the women's health space and that is testosterone and its impact on our health. So today we're going to bust some common myths and share essential facts about testosterone, especially focusing on our bone health and its role during menopause. You might have noticed that that testosterone has had a bit more interest and a bit more coverage in the media recently with a whole host of opinions, some from well educated and informed voices and others a little less so. So today, we'll bust some common myths and share essential facts about testosterone, particularly focusing on bone health and its role during menopause. Before we start, let's clarify what testosterone is. Testosterone is a hormone produced in both men and women. Although in different amounts. In women, testosterone is actually made in the ovaries. adrenal glands and in the peripheral tissues from other precursor type steroid hormones throughout our body. So yes, very much like oestrogen, we have testosterone receptors all over our body. And perhaps you might be surprised to hear that before we enter those menopause stages, testosterone is produced in far more abundance than it is oestrogen. So it's not just a male hormone. That's right. It is not just for men. The testosterone plays a crucial role in many of our bodily functions. It supports maintaining our bone density, our muscle mass and our energy levels. So despite common misconceptions, testosterone is not just a male hormone. We as women do indeed produce three times more testosterone than oestrogen before we hit those menopause years. So what are the impacts of testosterone on our bone health? This is the Strong Bones coach podcast after all. So testosterone has a significant impact on our bone health. It promotes bone formation and it reduces bone resorption, which is the act of breaking down our bone cells. So of course this is crucial to maintaining our bone density. During menopause, the decline in testosterone along with oestrogen can lead to a decreased bone density. which then leads to an increased risk of osteoporosis. So ensuring our testosterone levels are supported to adequate levels is key in preserving our bone health, especially as we age. Now there are some studies that have shown that testosterone therapy can help to maintain bone density and reduce the risk of fractures. So I will cover that off later on in this episode. So let's get to having a look at some myths versus facts, shall we? So number one, testosterone is only for men. So I've already covered this off, but let's cover it again. A reminder that yes, as women, we do also produce testosterone. It is important for health and it is especially important to maintain our bone density and our muscle mass. Myth number two, testosterone supplements our steroids. Well, this technically is not a myth. so testosterone is a steroid hormone, very much like parts of oestrogen and other steroid hormones throughout our body. So we have many other hormones that support our kidneys, our lungs, our brain, and these are all part of our normal bodily function. On one hand, yes, testosterone is a steroid hormone, but not in the terms that you might be thinking about it. When we often hear about the use of anabolic steroids that are sometimes misused within certain communities. But the difference in this situation is When we are supplementing testosterone, especially in the, in the context of a hormone deficiency, which is what we experience in menopause, we are only replacing towards normal levels for our female bodies. We are not trying to push our testosterone levels far beyond what they are supposed to be naturally within our body. With testosterone replacement therapy, the goal is to restore usual body function and overall health and well being, not to get our bodies to work outside of what they are naturally meant to do, unlike those who have been known to abuse these hormones. which I'm not getting into today, but I thought it would be helpful to just show the difference between the intentions when we're using testosterone. Myth number three, Testosterone causes severe side effects in women. The factual side of this is that when used correctly under proper medical supervision, proper dosage prescribing, testosterone support has minimal side effects. So some women may experience mild acne, a little extra hair growth, but this is really when the dosage is a little too high and when the blood levels of testosterone have gone a little beyond what is normal for you. So this is why support and supervision and help to take it properly and to monitor for any unwanted side effects that may not be supportive, in which case the dosage can be changed by a medical provider that is qualified to do this. And this is why it is so important that we work alongside our health providers beside those who are qualified to write those prescriptions to monitor those dosages alongside knowing your body, what is normal for you and what is wanted by you in terms of your life experience. So it's not just a case of being given a prescription, taking it and not questioning anything. It's very much prescriber, monitoring yourself, speaking to them about how your experience is. And of course, working together to make sure that dose is right, so that any side effects are in fact minimized. Myth number four, testosterone isn't necessary for women after menopause. So actually, the fact is our testosterone levels will decline with age, and this decline can have an impact on our bone density. It can have an impact on our muscle mass and our overall energy levels, our cognitive function, so that brain fog, that lack of motivation. That low energy level can be related to low testosterone levels. So, supporting these, bringing these up to normal levels, can support all of these impacts of menopause. Of course, when we are post menopausal, We can monitor ongoing testosterone levels and that need and that want for this to be part of our HRT. And of course, testosterone isn't the very first choice of our up hormone replacement. It's very often introduced after we have stabilized levels of oestrogen and progesterone. So it may not always be necessary for all women. It may not always be wanted for all women as part of their menopause care, but it is a conversation that wants to be had. So that we make these choices from an informed place. Myth number five, you can get testosterone from your diet Although the body does produce testosterone, if we want to replace the testosterone that is reducing as we age, then It will need to be a hormone that does this. So we are not able to produce testosterone based on what we eat from our diet. So although it's very important to maintain good nutrition and nourish our bodies well to support our whole body health, if we have low levels of testosterone, this is not something that we can correct with, say, food. or over the counter type supplementation that we might get in the health food shops, for example. So now that we've covered off a few myths, perhaps we can talk through some of the benefits of replacing low testosterone levels. So let's talk about maintaining our muscles and our strength levels. Testosterone absolutely helps with maintaining this. Testosterone helps in maintaining and increasing our muscle mass, which tends to decline with age and alongside that decrease in oestrogen. So there are studies to show that testosterone supplementation, especially combined with resistance training, will significantly improve muscle strength and performance. And yes, this may be why this is sometimes taken off prescription by some people in certain areas or spots. But this does not mean there is anything wrong with correcting low levels, bringing them up to normal levels. You will notice if you do have very low levels of testosterone, your energy levels will be low, which means your ability to perform in the gym, to lift weights, to move with intention to support your body will be reduced. And this can have longer term impacts on your ability to keep hold of the muscle that you have, and also in turn on your bone mass. So when we replace these levels, when your energy returns, so does your strength. So this is where you may see not only that increase in muscle because you're then able to perform in the gym, to look after yourself, to move better, but also the hormone environment in your body is more supportive. So next, improvements in your bone health. So testosterone does play a critical role in promoting bone density. So when we supplement this, it can help maintain your bone density and reduce your osteoporosis risk, which also reduces your risk of fractures. So the best available evidence right now has been done in men, and the findings have shown that there is an association between lower bone mineral density and the onset of osteoporosis. So this type of study has also been repeated more recently in women, which also found a correlation between lower testosterone levels in women aged 40 to 60 and increased incidence of osteoporosis. However, when we look at these scientific studies, we know that correlation does not always equal causation. We tend to need a better quality of study with some better controls in place to really be able to use this as part of an evidence base. now this does not necessarily mean that there is no evidence to support testosterone replacements in women as part of the HRT. But what it does show is that there's just not enough studies have taken place yet to really cement these findings into the evidence base. There is a lot of very supportive anecdotal evidence, and many of the women I work with have had vast improvements in their well being when they've topped up their low testosterone levels. But more solid evidence would certainly help support GPs with prescribing and women with accessing testosterone replacement therapy in a much more efficient way when needed, which is why I'm so grateful for the work of the Menopause Education and Research Fund. This is a charity focused on raising funds to support more research into menopause, which is severely lacking. So I'm so happy there is a focus on bringing forward this evidence to better support us as women taking control of our health. We're moving on. Cognitive support and our energy levels. Brain health is a hot topic as well. So as I mentioned, testosterone does support our brain energy metabolism and some of our cognitive functions. So if you are experiencing a lot of brain fog, a lot of fatigue, this can help return your energy stores as well as allowing your brain to function a little bit more like how you remember it working. So if you're noticing brain fog, if you're noticing your memory is struggling and you're already on oestrogen and progesterone support then it is well worth speaking to your health provider to see to have your testosterone levels checked and if they are low you may benefit from topping it up to normal levels. Now I'm going to make a small comment about how to take testosterone. I'm not going to cover this off in detail because this is between you, self, yourself and your health provider. But I know that sometimes there can be some confusion around this. So of course, it's crucial to work with your health care provider to determine the appropriate dosage and method of delivery. There are different ways to support and supplement your testosterone levels. This can include gels, patches, it can include injections, but more commonly, it's the gels that they would use over here in the UK, which is where I'm based. What we might find, what you might see, is that the current testosterone preparations are geared more towards men replacing their testosterone. So this doesn't mean you're going to be given a higher dose than what you need. Your prescriber will prescribe you a dose that is right for you and as a woman for what you need, for how your hormone profile looks. But what it does mean or what it can mean is that. your dosage is highly likely to be very much smaller than that of a man. So you may find yourself needing to spread out the gel sachets, for example, over a longer time period than what might be expected, for, if this was prescribed for a man. So you may need to have some additional supplies or additional different ways to apply. your gel, if you are using Testogel, for example. So what you might need to do is use some of these small airtight makeup pots, for example, and a small empty syringe. It'll help you adjust your dose much better, so that we're not just having that guess approach, because of course, getting the right dosage is important. So make sure you speak to your health care provider, and again, you may need to spread out the Supplementation a little differently in comparison to how men might do this. Of course, if you do want to talk through in a little more detail, and how you can be supported with this, then please do contact me on hello@carlykillencoaching.com. I'll be happy to help or perhaps signpost you to some more support if, more in depth help is needed with this. And of course, not everyone has been having the best time accessing or considering the testosterone therapy, which is why there's been so much media coverage about this recently. Because women are finding it difficult to access this. So in spite of the benefits, many women do struggle to get prescriptions due to perhaps a lack of awareness among certain healthcare providers. Some regulatory issues or perhaps confusion around what is appropriate prescribing practice. And of course there has been some stigma associated with testosterone therapy in women, perhaps due to the bad rap that's been given from those who have not taken it on prescription or that have taken it for reasons other than health. So just know it's important for you to be informed and to advocate for your own health. Seek a second opinion if you're facing obstacles in getting the treatment and support that you need. This is something I support many of my ladies with, so they have that empowered stance, that informed stance, so when they do approach a healthcare provider, they know how they feel, they know what's wanted and needed, and this goes so much more smoothly than if we go in unprepared and uninformed. And of course, let's make sure we're not forgetting the basics. So beside hormone replacement therapy, there are other ways to support your bone health, which I've covered in more depth in previous episodes, but here's just a little reminder to continue to support your foundations of health whilst exploring HRT support, even with testosterone in there too. So just a nod there to how you nourish your body, making sure you're getting a well balanced diet, plenty of colours, leafy greens, your sources of calcium and vitamin D, and your sunlight. Let's make sure we keep moving our bodies, doing our weight training and resistance training, keeping active for at least 30 minutes per day. And of course, there's lifestyle. supports, our mindset supports, our journaling, our time outdoors, if we can, avoid smoking and reducing alcohol intake if it's excessive. These are all things to, that can be covered off and supported as well as looking to where else we can support from the medical point of view as well. So bring in this week's episode to a close then. Testosterone is in fact vital in maintaining our bone health and our overall well being, especially as we navigate our way through menopause. So while there are challenges at times accessing testosterone therapy, it is important that you're educated in what you want and need so that you can advocate for your health. Remember to focus on your foundations. To support your whole life health, how to nourish yourself, how you support your movements and strength exercise, how your lifestyle supports you and your bone health. And of course, if you do have any questions or you would like some more personalized support, please do feel free to reach out to me on hello at Carly Killen coaching. com. Thank you for joining me today. I hope you found that informative and that you feel empowered to make the choices that you need for yourself. next week, stay strong, take care.